Practical recommendations for patient blood management and the reduction of perioperative transfusion in joint replacement surgery

Warwick Bruce, David Campbell, David John Daly, James Isbister

Research output: Contribution to journalArticleOtherpeer-review

Abstract

Data from the Australian Better Safer Transfusion programme show that about one-third of patients undergoing hip or knee arthroplasty receive perioperative blood transfusions, placing them at increased risk for adverse clinical outcomes. Other concerns associated with allogeneic blood transfusion include the quality of stored red cell concentrates, the cost of provision of blood and the predicted local demographics, which mean that fewer donors will need to support a greater number of recipients. In view of the multiple challenges associated with allogeneic blood transfusion and its provision, we developed practical management recommendations for perioperative bleeding in joint replacement surgery, based on available evidence and expert consensus opinion, that aim to promote a new, responsible approach to transfusion management. Key recommendations are as follows. Patients medical health, including haemoglobin and iron levels, needs to be evaluated and optimized preoperatively. Anticoagulant and antiplatelet therapy should be stopped if possible, unless indicated for secondary cardiovascular prevention or coronary stent patency, in which case careful consideration is required. If substantial blood loss is anticipated, intraoperative management with antifibrinolytic agents is recommended for bleeding prophylaxis. Normothermia should be maintained. Pharmacological and non-pharmacological measures are recommended for post-operative thromboprophylaxis. A blood management programme should be instituted for haemodynamically stable patients. ? 2012 The Authors ANZ Journal of Surgery ? 2012 Royal Australasian College of Surgeons.
Original languageEnglish
Pages (from-to)222-229
Number of pages8
JournalANZ Journal of Surgery
Volume83
Issue number4
DOIs
Publication statusPublished - 2013

Cite this

@article{8a37308d85da45898d07d99f5afa7251,
title = "Practical recommendations for patient blood management and the reduction of perioperative transfusion in joint replacement surgery",
abstract = "Data from the Australian Better Safer Transfusion programme show that about one-third of patients undergoing hip or knee arthroplasty receive perioperative blood transfusions, placing them at increased risk for adverse clinical outcomes. Other concerns associated with allogeneic blood transfusion include the quality of stored red cell concentrates, the cost of provision of blood and the predicted local demographics, which mean that fewer donors will need to support a greater number of recipients. In view of the multiple challenges associated with allogeneic blood transfusion and its provision, we developed practical management recommendations for perioperative bleeding in joint replacement surgery, based on available evidence and expert consensus opinion, that aim to promote a new, responsible approach to transfusion management. Key recommendations are as follows. Patients medical health, including haemoglobin and iron levels, needs to be evaluated and optimized preoperatively. Anticoagulant and antiplatelet therapy should be stopped if possible, unless indicated for secondary cardiovascular prevention or coronary stent patency, in which case careful consideration is required. If substantial blood loss is anticipated, intraoperative management with antifibrinolytic agents is recommended for bleeding prophylaxis. Normothermia should be maintained. Pharmacological and non-pharmacological measures are recommended for post-operative thromboprophylaxis. A blood management programme should be instituted for haemodynamically stable patients. ? 2012 The Authors ANZ Journal of Surgery ? 2012 Royal Australasian College of Surgeons.",
author = "Warwick Bruce and David Campbell and Daly, {David John} and James Isbister",
year = "2013",
doi = "10.1111/ans.12000",
language = "English",
volume = "83",
pages = "222--229",
journal = "ANZ Journal of Surgery",
issn = "1445-1433",
publisher = "Wiley-Blackwell",
number = "4",

}

Practical recommendations for patient blood management and the reduction of perioperative transfusion in joint replacement surgery. / Bruce, Warwick; Campbell, David; Daly, David John; Isbister, James.

In: ANZ Journal of Surgery, Vol. 83, No. 4, 2013, p. 222-229.

Research output: Contribution to journalArticleOtherpeer-review

TY - JOUR

T1 - Practical recommendations for patient blood management and the reduction of perioperative transfusion in joint replacement surgery

AU - Bruce, Warwick

AU - Campbell, David

AU - Daly, David John

AU - Isbister, James

PY - 2013

Y1 - 2013

N2 - Data from the Australian Better Safer Transfusion programme show that about one-third of patients undergoing hip or knee arthroplasty receive perioperative blood transfusions, placing them at increased risk for adverse clinical outcomes. Other concerns associated with allogeneic blood transfusion include the quality of stored red cell concentrates, the cost of provision of blood and the predicted local demographics, which mean that fewer donors will need to support a greater number of recipients. In view of the multiple challenges associated with allogeneic blood transfusion and its provision, we developed practical management recommendations for perioperative bleeding in joint replacement surgery, based on available evidence and expert consensus opinion, that aim to promote a new, responsible approach to transfusion management. Key recommendations are as follows. Patients medical health, including haemoglobin and iron levels, needs to be evaluated and optimized preoperatively. Anticoagulant and antiplatelet therapy should be stopped if possible, unless indicated for secondary cardiovascular prevention or coronary stent patency, in which case careful consideration is required. If substantial blood loss is anticipated, intraoperative management with antifibrinolytic agents is recommended for bleeding prophylaxis. Normothermia should be maintained. Pharmacological and non-pharmacological measures are recommended for post-operative thromboprophylaxis. A blood management programme should be instituted for haemodynamically stable patients. ? 2012 The Authors ANZ Journal of Surgery ? 2012 Royal Australasian College of Surgeons.

AB - Data from the Australian Better Safer Transfusion programme show that about one-third of patients undergoing hip or knee arthroplasty receive perioperative blood transfusions, placing them at increased risk for adverse clinical outcomes. Other concerns associated with allogeneic blood transfusion include the quality of stored red cell concentrates, the cost of provision of blood and the predicted local demographics, which mean that fewer donors will need to support a greater number of recipients. In view of the multiple challenges associated with allogeneic blood transfusion and its provision, we developed practical management recommendations for perioperative bleeding in joint replacement surgery, based on available evidence and expert consensus opinion, that aim to promote a new, responsible approach to transfusion management. Key recommendations are as follows. Patients medical health, including haemoglobin and iron levels, needs to be evaluated and optimized preoperatively. Anticoagulant and antiplatelet therapy should be stopped if possible, unless indicated for secondary cardiovascular prevention or coronary stent patency, in which case careful consideration is required. If substantial blood loss is anticipated, intraoperative management with antifibrinolytic agents is recommended for bleeding prophylaxis. Normothermia should be maintained. Pharmacological and non-pharmacological measures are recommended for post-operative thromboprophylaxis. A blood management programme should be instituted for haemodynamically stable patients. ? 2012 The Authors ANZ Journal of Surgery ? 2012 Royal Australasian College of Surgeons.

UR - http://dx.doi.org/10.1111/ans.12000

U2 - 10.1111/ans.12000

DO - 10.1111/ans.12000

M3 - Article

VL - 83

SP - 222

EP - 229

JO - ANZ Journal of Surgery

JF - ANZ Journal of Surgery

SN - 1445-1433

IS - 4

ER -